Faculty Profiles - FUJIWARA Toshiyoshi

Papers - FUJIWARA Toshiyoshi

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ロボット肝胆膵手術のコツとピットフォールロボット支援下膵切除術のコツとピットフォール

高木弘誠, 楳田祐三, 吉田龍一, 吉田一博, 藤智和, 熊野健二郎, 安井和也, 佐藤博紀, 八木孝仁, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) PD1 - 5 2021.12

腹腔鏡下右葉系系統的肝切除の定型化腹腔鏡下肝後区域切除の定型化

楳田祐三, 藤智和, 高木弘誠, 吉田一博, 安井和也, 野間和広, 黒田新士, 吉田龍一, 八木孝仁, 藤原俊義

日本内視鏡外科学会雑誌 26 ( 7 ) PD2 - 3 2021.12

Technique of vessel-skeletonized parenchyma-sparing hepatectomy for the oncological treatment of bilobar colorectal liver metastases

Yuzo Umeda, Takeshi Nagasaka, Kosei Takagi, Ryuichi Yoshida, Kazuhiro Yoshida, Tomokazu Fuji, Tatsuo Matsuda, Kazuya Yasui, Kenjiro Kumano, Hiroki Sato, Takahito Yagi, Toshiyoshi Fujiwara

Langenbeck's Archives of Surgery 2021.11

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

<title>Abstract
</title><sec>
<title>Background</title>
To aid in the oncological management of multiple bilobar colorectal liver metastases (CRLMs), we describe a new surgical procedure, VEssel-Skeletonized PArenchyma-sparing Hepatectomy (VESPAH).

</sec><sec>
<title>Study design</title>
Of 152 patients with CRLMs treated with hepatectomy, 33 patients had multiple bilobar liver metastases (≥8 liver metastases); their surgical procedures and clinical outcomes were retrospectively summarized and compared between those who underwent VESPAH and those who underwent major hepatectomy (Major Hx).

</sec><sec>
<title>Results</title>
Of the 33 patients, 20 patients were resected by VESPAH (the VESPAH group) and 13 patients by major hepatectomy (Major Hx group). The median number of CRLMs was 13 (range, 8–53) in the VESPAH group and 10 (range, 8–41) in the Major Hx group (<italic>P</italic>=0.511). No operative mortality nor severe morbidity was observed in either group. The VESPAH group showed earlier recovery of remnant liver function after surgery than the Major Hx group; the incidence of grade B/C post hepatectomy liver failure was 5% in the VESPAH group and 38% in the Major Hx group, <italic>P</italic>=0.048). Intrahepatic tumor recurrence was confirmed in 14 (70%) and 7 (54%) patients in the VESPAH and Major Hx groups, respectively (<italic>P</italic>=0.416). There was no significant difference in median overall survival (OS) after hepatectomy between the two groups; the median OS was 47 months in the VESPAH group and 33 months in the Major Hx group (<italic>P</italic>=0.481). The VESPAH group showed the higher induction rate of adjuvant chemotherapy within 2 months after surgery (<italic>P</italic>=0.002) and total number of repeat hepatectomy for intrahepatic recurrence (<italic>P</italic>=0.060) than the Major Hx group.

</sec><sec>
<title>Conclusions</title>
VESPAH enables us to clear surgical navigation by hepatic vessel skeletonization and may enhance patient tolerability of not only adjuvant chemotherapy but also repeat hepatectomies during the patients’ lifetimes.

</sec>

DOI： 10.1007/s00423-021-02373-9

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Other Link： https://link.springer.com/article/10.1007/s00423-021-02373-9/fulltext.html

胆嚢結石症術後に診断された胃癌の異時性胆嚢転移の1例

杉本龍馬, 垣内慶彦, 黒田新士, 菊地覚次, 庄司良平, 西田賢司, 西崎正彦, 香川俊輔, 藤原俊義

日本消化器外科学会雑誌 54 ( 11 ) 788 - 794 2021.11

Language：Japanese Publisher：(一社)日本消化器外科学会

症例は77歳の男性で,検診にて発見された胃癌に対してロボット支援下胃全摘術,D2郭清,Roux-en Y再建術を施行した.術後病理組織学的診断は,pT4a(SE)N3aM0 Stage IIIBであった.術後補助化学療法として,S-1を3コース施行した時点でCEAの上昇を認めたが,画像検査にて明らかな再発を認めなかったため治療を継続し,1年後の補助化学療法終了時には正常値まで低下した.術後26ヵ月経過時に急性胆管炎,胆嚢結石を認めたため,保存的加療後に待機的に腹腔鏡下胆嚢摘出術を行った.術前画像所見や術中所見で胆嚢に特記すべき所見は認めなかったが,術後病理組織学的診断にて,胃癌の胆嚢転移と診断された.極めてまれな胃癌の異時性胆嚢転移の1例を経験したため報告する.(著者抄録)

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情熱・努力を継続できる外科教育外科生涯教育におけるCSTの果たす役割

近藤喜太, 前田直見, 黒田新士, 信岡大輔, 武田正, 重安邦俊, 菊地覚次, 矢野修也, 田辺俊介, 野間和広, 楳田祐三, 寺石文則, 香川俊輔, 白川靖博, 藤原俊義

日本外科学会雑誌 122 ( 6 ) 674 - 676 2021.11

80歳以上高齢者食道癌症例に対する安全性と根治性の両立を目指した外科治療戦略

田辺俊介, 野間和広, 前田直見, 菊地覚次, 黒田新士, 近藤喜太, 櫻間教文, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本消化器外科学会雑誌 54 ( Suppl.2 ) 243 - 243 2021.11

情熱・努力を継続できる外科教育外科マネージメントセンターによる情熱のある外科医教育・育成システム

菊地覚次, 吉田龍一, 黒田新士, 野間和広, 安井和也, 笠原真悟, 豊岡伸一, 土井原博義, 藤原俊義

日本外科学会雑誌 122 ( 6 ) 680 - 682 2021.11

Application of convolutional neural networks for evaluating the depth of invasion of early gastric cancer based on endoscopic images. International journal

Kenta Hamada, Yoshiro Kawahara, Takayoshi Tanimoto, Akimitsu Ohto, Akira Toda, Toshiaki Aida, Yasushi Yamasaki, Tatsuhiro Gotoda, Taiji Ogawa, Makoto Abe, Shotaro Okanoue, Kensuke Takei, Satoru Kikuchi, Shinji Kuroda, Toshiyoshi Fujiwara, Hiroyuki Okada

Journal of gastroenterology and hepatology 2021.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND AIM: Recently, artificial intelligence (AI) has been used in endoscopic examination and is expected to help in endoscopic diagnosis. We evaluated the feasibility of AI using convolutional neural network (CNN) systems for evaluating the depth of invasion of early gastric cancer (EGC), based on endoscopic images. METHODS: This study used a deep CNN model, ResNet152. From patients who underwent treatment for EGC at our hospital between January 2012 and December 2016, we selected 100 consecutive patients with mucosal (M) cancers and 100 consecutive patients with cancers invading the submucosa (SM cancers). A total of 3508 non-magnifying endoscopic images of EGCs, including white-light imaging, linked color imaging, blue laser imaging-bright, and indigo-carmine dye contrast imaging, were included in this study. A total of 2288 images from 132 patients served as the development dataset, and 1220 images from 68 patients served as the testing dataset. Invasion depth was evaluated for each image and lesion. The majority vote was applied to lesion-based evaluation. RESULTS: The sensitivity, specificity, and accuracy for diagnosing M cancer were 84.9% (95% confidence interval [CI] 82.3%-87.5%), 70.7% (95% CI 66.8%-74.6%), and 78.9% (95% CI 76.6%-81.2%), respectively, for image-based evaluation, and 85.3% (95% CI 73.4%-97.2%), 82.4% (95% CI 69.5%-95.2%), and 83.8% (95% CI 75.1%-92.6%), respectively, for lesion-based evaluation. CONCLUSIONS: The application of AI using CNN to evaluate the depth of invasion of EGCs based on endoscopic images is feasible, and it is worth investing more effort to put this new technology into practical use.

DOI： 10.1111/jgh.15725

PubMed

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Splenic and Peritoneal Metastases with Para-aortic and Virchow Lymph Node Metastases: Late Recurrence of Ovarian Cancer 30 Years after Initial Treatment.

Kosei Takagi, Takahito Yagi, Toshiyoshi Fujiwara

JMA journal 4 ( 4 ) 428 - 431 2021.10

Early intervention of the perioperative multidisciplinary team approach decreases the adverse events during neoadjuvant chemotherapy for esophageal cancer patients.

Yasuhiro Shirakawa, Kazuhiro Noma, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Ayumi Sonoyama-Hanaoka, Aiko Yoshitomi, Reiko Kohno-Yamanaka, Yoshihiko Soga, Toshiyoshi Fujiwara

Esophagus : official journal of the Japan Esophageal Society 18 ( 4 ) 797 - 805 2021.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Multidisciplinary team (MDT) approach has become a standard for perioperative patient care, including in esophageal cancer. In our institution, the Perioperative Management Center (PERiO) has been doing an MDT approach for patients undergoing esophageal cancer surgery since 2009. On the other hand, neoadjuvant therapy has also been becoming standard for many malignancies, including esophageal cancer. In Japan, neoadjuvant chemotherapy (NAC) for esophageal cancer is standard now. However, there have been no reports about when is the best time to start the MDT approach for patients with neoadjuvant therapy. In this study, the best start time for the MDT approach for esophageal cancer patients with NAC was examined from the perspective of adverse events during chemotherapy and perioperative period. METHODS: All cases underwent thoracoscopic esophagectomy in the prone position (TEPP) after NAC. The PERiO Intervention group that started before NAC (n = 100) was compared with the PERiO Intervention group that started after NAC (n = 77). Eventually, 54 paired cases were matched by propensity score matching. RESULTS: The adverse event rate during chemotherapy, especially oral complications, was significantly decreased in the PERiO Intervention started before the NAC group (P = 0.007). Furthermore, weight loss during the period from chemotherapy to surgery was significantly reduced in the group that started before NAC (P = 0.033). CONCLUSION: The MDT approach should be started before NAC in patients undergoing esophageal cancer surgery to prevent adverse events during chemotherapy and provide safe perioperative conditions.

DOI： 10.1007/s10388-021-00844-y

PubMed

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臓器移植におけるNew Normalを考える肝移植における免疫抑制のニューノーマルこれからの時代を見据えた免疫抑制の最適化

楳田祐三, 八木孝仁, 藤原俊義

Organ Biology 28 ( 3 ) 56 - 56 2021.10

ロボット支援下手術における私の工夫ロボット支援下手術の導入により見えてきた新たなアプローチ食道癌左上縦隔郭清術

野間和広, 最所公平, 前田直見, 菊地覚次, 黒田新士, 近藤喜太, 櫻間教文, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本癌治療学会学術集会抄録集 59回 WS9 - 3 2021.10

Charlson comorbidity indexは80歳高齢者stage IA胃癌の予後因子である

黒田新士, 垣内慶彦, 武田正, 菊地覚次, 重安邦俊, 矢野修也, 近藤喜太, 田辺俊介, 野間和広, 吉田龍一, 楳田祐三, 寺石文則, 西崎正彦, 香川俊輔, 藤原俊義

日本癌治療学会学術集会抄録集 59回 O48 - 6 2021.10

切除不能消化器癌に対するconversion surgeryの適応とタイミング骨盤内臓全摘術が高度進行大腸癌へのコンバージョン手術となるかはRAS statusで決まる

矢野修也, 重安邦俊, 垣内慶彦, 武田正, 菊地覚次, 近藤喜太, 黒田新士, 田辺俊介, 野間和広, 吉田龍一, 楳田祐三, 寺石文則, 西崎正彦, 香川俊輔, 藤原俊義

日本癌治療学会学術集会抄録集 59回 WS18 - 4 2021.10

周術期管理における多職種チーム医療管理栄養士による患者教育プロトコールの胃癌術後体重減少、サルコペニア抑制効果

今井祥子, 菊地覚次, 高田暢夫, 黒田新士, 田辺俊介, 前田直見, 西崎正彦, 野間和広, 香川俊輔, 楳田祐三, 縄稚久美子, 高橋絢子, 長谷川祐子, 四方賢一, 藤原俊義

日本癌治療学会学術集会抄録集 59回 WS7 - 6 2021.10

胃切除後食道癌再建のベストプラクティス結腸vs.空腸胃を使用できない症例に対する安全で生理的な再建を目指した有茎空腸を用いた食道再建術

白川靖博, 桂佑貴, 石田道拡, 丁田泰宏, 矢野琢也, 佐藤大祐, 義満政義, 中野敢友, 松川啓義, 井谷史嗣, 岡島正純, 塩崎滋弘, 橋本将志, 前田直見, 田辺俊介, 野間和広, 藤原俊義

日本胸部外科学会定期学術集会 74回 EDB1 - 3 2021.10

岡山大学外科広域外科専門研修プログラム関連病院における専攻医の産前産後休暇・育児休業/休暇・介護休業/休暇、その他支援についての実態調査

竹原裕子, 溝尾妙子, 小林純子, 菊地覚次, 池田宏国, 岡崎幹生, 吉田龍一, 黒田新士, 枝園忠彦, 小谷恭弘, 山根正修, 豊岡伸一, 笠原真悟, 土井原博義, 藤原俊義

日本臨床外科学会雑誌 82 ( 増刊 ) S24 - S24 2021.10

術前から術後まで幅広くサポートする多職種による食道がん周術期管理

田辺俊介, 野間和広, 前田直見, 菊地覚次, 黒田新士, 近藤喜太, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本臨床外科学会雑誌 82 ( 増刊 ) S550 - S550 2021.10

食道癌に対する内視鏡下手術の技術取得と向上胸腔鏡下食道癌手術の技術習得と向上への取り組み

前田直見, 野間和広, 菊地覚次, 黒田新士, 田辺俊介, 近藤喜太, 吉田龍一, 櫻間教文, 寺石文則, 白川靖博, 楳田祐三, 藤原俊義

日本臨床外科学会雑誌 82 ( 増刊 ) S480 - S480 2021.10

食道癌術後乳糜胸に対する治療マネージメント

永久成一, 野間和広, 前田直見, 菊地覚次, 黒田新士, 田邊俊介, 近藤喜太, 吉田龍一, 寺石文則, 楳田祐三, 白川靖博, 藤原俊義

日本臨床外科学会雑誌 82 ( 増刊 ) S603 - S603 2021.10

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Papers - FUJIWARA Toshiyoshi